tbuckley/cabot-search huggingface dataset:
Abstract 11793: Rates and Causes of Readmission in Patients With Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis of 17,860 Index Hospitalizations
Authors: Avilash Mondal, Nishanth Katukuri, Sai Gautham Kanagala, Adil S Mohammed, Priyatham Gurram, Mariam Ashfaque, Amara Sofia, Humaira Kauser, Qudsia Sayyeda, Satya Sai Venkata Lakshmi Arepalli, Rupak Desai
Journal: Circulation (2022)

Background: The risk of fatal and recurrent cardiovascular complications in Hypertrophic Cardiomyopathy (HCM) warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index HCM admissions. Methods: PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through May 2022 reporting rates and causes of readmission following index HCM admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I 2 statistics were used to report inter-study heterogeneity. Results: This meta-analysis included 17860 index HCM admissions (Mean age: 46-67 years, median follow up duration: 321.6 days, Female 53.11%) from 17 studies, which revealed a 14.8% [95% CI 12.2%-17.4%, I 2 =96%] pooled rate of readmission (Fig. 1) . Studies published from China (23.5% vs. 10.5%) had a higher readmission rate than the USA (Fig. 2) . The long-term readmission rate was highest within 1-3 years (26.6%) and in patients who underwent alcohol septal ablation procedure (10% vs 7.6%) compared to those who underwent surgical myectomy (Fig. 3) . The readmission rate was higher in cohorts with smaller sample sizes (19.2% vs 10.2%) (n&lt;1000 vs. n&gt;1000). Among the readmission events, congestive heart failure, and acute decompensated heart failure were the leading causes of readmission, accounting for up to 66% of the readmission cases [95%CI 32.5%-100.4%, p&lt;0.001] following index admissions. Conclusions: In this global meta-analysis, the pooled rate of readmission following index HCM hospitalizations was nearly 15% over a year's follow-up, with heart failure accounting for two-thirds of the readmissions.
Abstract 11699: In Hospital Outcomes of Acute Coronary Artery Dissection and Obesity
Authors: Richard Orji, Kelechukwu U Okoro, Favour Markson, Ebubechukwu Ezeh, Muftawu-Deen Iddrisu, Ayodeji Ilelaboye, Emmanuel Ukenenye, Ali Horoub, Emeka Okoronkwo
Journal: Circulation (2022)

Introduction: Coronary artery dissection is an emergency condition due to a tear in the coronary arterial wall, and it’s an uncommon cause of acute coronary syndrome. The Effect of Obesity on the outcome of acute coronary artery dissection is poorly documented. Hence, our study sought to estimate the impact of Obesity on clinical outcomes of hospitalizations of patients with acute Coronary artery dissection using the national database. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with acute Coronary artery dissection as a principal diagnosis with and without Obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. Results: About 2440 patients were admitted for acute Coronary artery dissection; 17.4% (425) had underlying obesity. Cohorts with obesity vs No obesity had a mean age of 52.9 years [CI 50.4 - 55.5] vs 55.9 years [CI 54.5 - 57.4]; male (20% vs 25.8%), female (80% vs 74.2%); white (71.3% vs 73.3%), black (21.3% vs 12.0%), and Hispanic (6.3% vs 7.8%). Compared to patients without obesity, patients admitted with coexisting obesity had similar inpatient mortality (7.1% vs 3.2%, AOR 3.22, 95% CI 0.74 - 13.88, P=0.118), AKI (15.3% vs 9.9%, P 0.357), CS (9.4% vs 11.2% P=0.098), CA (5.9% vs 5.0% P=0.530), THC (IRR 0.94, 95% CI 0.64 - 1.37, P=0.738), and LOS (IRR 0.79, 95% CI 0.59 - 1.05, P=0.107). Conclusions: Patients admitted primarily for acute Coronary artery dissection with co-existing Obesity had similar inpatient mortality, AKI, CS, CA, THC, and LOS compared to patients without Obesity.
Abstract 11634: Fatty Acid Length Dictates Association of Sphingomyelins With Sudden Cardiac Death
Authors: Lee Bockus, Paul Jensen, Amanda M Fretts, Andy Hoofnagle, Colleen Sitlani, David Siscovick, Bruce M Psaty, Nona Sotoodehnia, Rozenn N Lemaitre
Journal: Circulation (2022)

Background: Sudden cardiac death (SCD) is a leading cause of mortality worldwide and is precipitated primarily by ventricular tachyarrhythmias related to coronary artery disease. Sphingolipids, composed of ceramides and sphingomyelins, may influence the pathophysiology and risk of SCD through multiple biological activities. Whether the length of the fatty acid conjugated to the sphingolipid species is associated with SCD risk is not known. Methods and Results: Among 4612 Cardiovascular Health Study participants, we identified 215 patients who experienced SCD over a median follow up of 10.2 years. We examined 8 sphingolipids: ceramide and sphingomyelin species containing palmitic acid and species containing, respectively, the very-long-chain saturated fatty acids (VLSFA) arachidic, behenic, and lignoceric acids. In adjusted Cox regression analyses, ceramides and sphingomyelins with palmitic acid were associated with increased SCD risk per standard deviation log difference (ceramide with palmitic acid: hazard ratio 1.34, 95% CI 1.12-1.59; sphingomyelin with palmitic acid: hazard ratio 1.37, 95% CI 1.12-1.67). In contrast, one sphingomyelin with a VLSFA trended towards an association with reduced SCD risk (sphingomyelin with arachidic acid: hazard ratio 0.83, 95% CI 0.71-0.98). Associations were weakened when adjusted for C-reactive protein (CRP), B-type natriuretic peptide, and troponin-T, but did not differ significantly by age, sex, race, body-mass index, or history of coronary heart disease. In comparison, ceramide with palmitic acid was associated with higher risk of nonfatal myocardial infarction, and ceramide with the VLSFA lignoceric acid trended towards lower risk. Conclusions: Our results suggest associations between sphingolipid species and SCD, differing by the length of the acylated saturated fatty acid. Palmitic acid-containing sphingolipids were strongly associated with increased SCD risk, whereas VLSFA-containing sphingomyelins trended toward reduced SCD risk. The study indicates that plasma sphingolipids may influence the risk of SCD, independent of traditional cardiovascular risk factors. Our findings may provide further insight into the pathogenesis of SCD and enhance risk stratification tools.
Abstract 12130: Cardiac Arrest as a Result of Anaphylactic Reaction From MAb Infusion for COVID-19
Authors: ZEINAB Abdulrahman, Hayder Azeez, Jocelyn McCullough, andrew weber, Marilyn Temkin
Journal: Circulation (2022)

Introduction: Anaphylaxis is a severe, life-threatening, systemic hypersensitivity reaction. Severe cases may result in complete obstruction of the airway and cardiovascular collapse. Monoclonal antibody (MAb) products with anaphylactic potential are being used to treat COVID-19 through an FDA Emergency Use Authorization (EUA). Case Presentation: An 86-year-old male was referred to our hospital for thoracentesis. Medical history was significant for CLL, Atrial fibrillation, and type 2 diabetes mellitus. He had completed a 3-dose vaccination series for COVID-19. On the physical he was eutensive, afebrile, and was noted to have diminished breath sounds at the right lower lobe. Chest Xray showed right sided moderate pleural effusion. EKG showed atrial fibrillation. Thoracentesis was performed without complication. After this procedure, the patient’s PCR for COVID-19 returned positive. He met the criteria for MAb infusion and was provided bebtelovimab 175 mg intravenously. One minute later the patient became unresponsive, cyanotic, and bradycardic to 38 beats per minute. ACLS protocol was administered and 1mg atropine provided. After 1 cycle, ROSC was achieved and the patient was endotracheally intubated due to persistent altered consciousness. The patient was transferred to the ICU requiring intravenous vasopressors and remained intubated for 24 hours. He was extubated to Bilevel NIV, and weaned in the ambient air. TTE was performed and showed severe pulmonary HTN and an EF of 60%-65%. He was provided diuresis and discharged from the ICU. Conclusion: Anti-SARS-CoV-2 MAbs have been used for patients with mild to moderate COVID-19 who are hospitalized for reasons other than COVID-19 per FDA EUA criteria. Such treatments have been known to cause anaphylaxis in the past, although due to a dearth of complications, they may be underappreciated. This case brings attention to the serious anaphylactic reactions that can be caused by MAb and demonstrates the need for observation with ACLS capable equipment post-infusion.
Abstract 11761: Increasing Trend in All-Cause Mortality Among Elderly Black Patients Hospitalized With Acute Myocardial Infarction With Prior Coronary Artery Bypass Grafting - A Nationwide Inpatient Analysis 2016-2019
Authors: Dharshana Prem Anand, Warda Shahnawaz, Avinaash Raja Sager, Sai Shanmukha Sreeram Pannala, Aleen Rahman, April Kristine Miguel, Pratiksha Shankarlal Nathani, Sai Prasanna Lekkala, Sashwath Srikanth, Rupak Desai
Journal: Circulation (2022)

Background: Acute myocardial infarction (AMI) in elderly patients who have previously undergone coronary artery bypass grafting (CABG) poses a diagnostic and therapeutic complexity. There is limited data on cardiovascular and mortality outcomes for this population. Methods: Using the National Inpatient Sample (NIS) from 2016-2019, we identified patients over 65 years with a prior CABG presenting with AMI, excluding those with a history of percutaneous coronary intervention. After assessing baseline characteristics, we analyzed trends in cardiovascular disease (CVD) risk and all-cause in hospital mortality (ACM) while stratifying for gender and race. Pearson’s chi-squared test was utilized to compare the CVD variables. Results: There were 266,365 hospitalizations included in the study with a median age of 77 years. They were predominantly males(69.5%), of Caucasian origin (81.7%), Medicare enrollees (91.4%) and were admitted in urban teaching hospitals (67.2%) located in the South of the US (39.5%) as non-elective cases (93.8%). Between 2016-19, Hyperlipidemia (HLD), smoking(Sm), and obesity(Ob) showed an increasing trend in males (2.8%, 1.3%, and 2% respectively) and females (2.1%, 2.4%, and 2% respectively), whereas hypertension (HTN) decreased by 4.5% in males and 6.3% in females.The length of stay remained constant at 4 days and the average cost of stay was 58963.5 USD. HTN among all races decreased from 2016 to 2019 except for Native Americans. HLD and obesity exhibited an upward trend among all races. Hispanics and Asians/Pacific Islanders(PI) had a consistent downtrend in mortality rates, with Native Americans showing the biggest drop in mortality rate (6.9%). All-cause mortality decreased from 2016 to 2019 by 1.4% except for Blacks which has increased by 2.6%, overtaking Asian/PI. All p&lt;0.001. Conclusion: More research is needed to determine the factors contributing to the increased all-cause mortality trend in Black patients admitted with AMI.
Abstract 12164: Gendered Social Determinants of Health and Risk of Major Adverse Outcomes in Atrial Fibrillation: An Analysis From the ESC-EHRA Eurobservational Research Programme in Atrial Fibrillation General Long-Term Registry
Authors: Jonathan Houle, Marco Proietti, Valeria Raparelli, Zahra Azizi, Clare Atzema, Colleen M Norris, Michal Abrahamowicz, Gregory Lip, Giuseppe Boriani, Louise Pilote
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is associated with a high risk of adverse outcomes. Social determinants of health (SDOH) are gendered (unevenly distributed between females and males) and associated with outcomes in cardiovascular diseases. Little is known about their impact in AF. We evaluated the association between gendered SDOH and adverse outcomes in AF patients. Methods: Data came from the ESC-EHRA EORP-AF General Long-Term Registry, a European AF prospective registry. Gendered SDOH included: education, living alone vs not, smoking, alcohol use, gender inequality index (GII), physical activity and quality of life measures. Study outcome was a composite of major adverse cardiovascular events and all-cause death. SDOH main effect was tested in multivariate logistic regressions and for a sex/GII interaction. Results: We studied 11,096 patients (mean (SD) age 69.2 (11.4) years; 40.7% females, median [IQR] CHA 2 DS 2 -VASc score 3 [2-4]). Most had secondary education, did not live alone, did not smoke or use alcohol, were physically inactive, had moderate quality of life, and lived in countries with gender equity. Multivariate analyses showed that gendered SDOH together with traditional risk factors were associated with the outcome (Figure 1). Higher education level and quality of life were associated with lower risk of adverse outcomes. Conversely, living alone and higher GII (larger gender inequity) were associated with worse outcomes. Females were found at lower risk, however this protective effect was reversed in countries with higher GII (sex-GII p- interaction 0.048). Conclusions: Gendered SDOH are associated with adverse outcomes in AF. Notably, gender inequity confers poorer outcomes in females with AF.
Abstract 11231: Acetylcholine Receptor Agonists Exert Cardioprotection Against Trastuzumab-Induced Cardiotoxicity by Attenuating NLRP3/GSDMD-Mediated Pyroptosis
Authors: Nanthip Prathumsap, Benjamin Ongnok, Thawatchai Khuanjing, Apiwan Arinno, Chayodom Maneechote, Titikorn Chunchai, Busarin Arunsak, Sasiwan Kerdphoo, Siriporn Chattipakorn, Nipon Chattipakorn
Journal: Circulation (2022)

Introduction: The most significant adverse effect of trastuzumab (TRZ) is cardiotoxicity. Multiple factors are involved in the pathogenesis of TRZ-induced cardiotoxicity (TIC), including mitochondrial dysfunction, inflammation, and pyroptosis. Although vagal modulation using acetylcholine receptors (AChR) agonists have been shown to exert cardioprotection in various heart diseases, the effects of AChR agonists against TIC have not been investigated. Hypothesis: We hypothesized that AChR agonists exert cardioprotective effects against TIC by attenuating cardiac mitochondrial dysfunction, inflammation, and cardiomyocyte pyroptosis, leading to improved left ventricular (LV) function. Methods: Wistar rats were divided into 5 groups, including i) control (0.9%NSS), ii) TRZ+VEH (TRZ, 4 mg/kg+VEH), iii) TRZ+α7 nicotinic AChR agonist (α7nAChR: PNU-282987, 3 mg/kg/day), iv) TRZ+muscarinic AChR agonist (mAChR: bethanechol, 12 mg/kg/day), and v) combined PNU+BET treatment groups (COM). At the end of the experiments, cardiac biochemical and functional analyses were determined. Results: TRZ-treated rats showed a decreased %LV ejection fraction (%LVEF) (Fig. 1A). Moreover, mitochondrial reactive oxygen species (ROS) levels and mitochondrial depolarization were increased in TIC rats (Fig. 1B-C). TRZ-treated rats also exhibited the upregulation of interleukin-6 mRNA, NLR family pyrin domain containing, and cleaved-gasdermin D/gasdermin expression (Fig. 1D-F). All AChR agonists similarly protected the hearts by attenuating cardiac mitochondrial dysfunctions, inflammation, and pyroptosis, leading to improved LV function in TIC rats (Fig. 1A-F). Conclusions: Either α7nAChR or mAChR agonist equally exerted cardioprotective effects against TIC by reducing cardiac mitochondrial dysfunction, inflammation, and pyroptosis, culminating in improved LV function. These findings provide potential novel treatment strategies against TIC.
Abstract 11187: Impact of Hypertriglyceridemia on Cardiovascular Mortality According to Low-Density Lipoprotein Cholesterol in a 15.6-Million Population
Authors: Hyung-Bok Park, Reza Arsanjani, Sung-jin Hong
Journal: Circulation (2022)

Introduction: The role of hypertriglyceridemia (HTG) in cardiovascular disease (CVD) remains controversial, especially in persons with well-controlled low-density lipoprotein cholesterol (LDL-C). Hypothesis: We aimed to evaluate the association between triglyceride (TG) levels and CVD mortality according to LDL-C and age in a general population. Methods: From the Korean National Health Insurance Service database, 15,672,028 participants aged 18-99 who underwent routine health examinations were followed up for CVD mortality. Hazard ratios (HRs) for CVD mortality were calculated using Cox models after adjusting for various confounders. Results: During a mean 8.8 years of follow-up, 105,174 individuals died from CVD. There was a clear log-linear association between TG and overall CVD mortality down to 50 mg/dL. Each two-fold increase in TG was associated with 1.10-fold (overall CVD), 1.22-fold (ischemic heart disease [IHD]), 1.24-fold (acute myocardial infarction [AMI]), and 1.10-fold (ischemic stroke) higher CVD mortality. Hemorrhagic stroke and heart failure were not associated with TG levels. The impact of HTG on CVD weakened but remained present in persons with LDL-C &lt;100 mg/dL, in whom each two-fold higher TG was associated with 1.05-fold (overall CVD), 1.12-fold (IHD), 1.15-fold (AMI), and 1.05-fold (ischemic stroke) higher CVD mortality. The younger population (18 to 44 years) had stronger associations between TG levels and mortality from overall CVD, IHD, and AMI than the older population. Conclusions: HTG independently increases CVD mortality. There are residual risks of HTG in both young and older individuals with a low level of LDL-C. HTG management might be beneficial in individuals with well-controlled LDL-C.
Abstract 12518: Echocardiographic Features and Natural History of Right Ventricular Dysfunction in Cardiac Sarcoidosis With or Without Pulmonary Involvement
Authors: Daniel Sykora, Tyler J Schmidt, Mohamed Y Elwazir, Nikhil Kolluri, Panithaya Chareonthaitawee, Omar F Abou-Ezzeddine, Courtney A Arment, John Bois, John Giudicessi, Leslie T Cooper, Andrew Rosenbaum
Journal: Circulation (2022)

Introduction: Cardiac sarcoidosis (CS) is a non-ischemic disease which can present with right ventricular (RV) dysfunction, but there is a paucity of research describing RV function and natural history in CS. Methods: We queried a registry of 512 CS patients for those with baseline and follow-up echocardiography (TTE). Demographics, medications, and baseline/follow-up TTE data were collected. RV-pulmonary arterial (RV-PA) coupling was approximated by ratio of tricuspid annular plane systolic excursion to estimated pulmonary artery systolic pressure (TAPSE:ePASP). Results: Our query yielded 343 CS patients with mean age 56y (σ=12y), who were predominantly male (67%) and white (90%) with a median follow-up 4y (interquartile range 4.1y). Most had pulmonary sarcoidosis (68%). Baseline TTE data showed left ventricular ejection fraction 48% (σ=14), abnormal RV function with RV systolic pressure (ePASP) 34 mmHg (σ=11), TAPSE 21mm (σ=5), RV S′ 0.14 m/s (σ=0.07), and RV-PA uncoupling (TAPSE:ePASP 0.69 mm/mm Hg, σ=0.25). Baseline RV function parameters did not differ by pulmonary involvement of sarcoidosis. 92% received immunosuppression and 65% received neurohormonal blockade. In long-term follow-up, the overall cohort demonstrated a trend towards worsening of both RV S’ and RV-PA coupling (P=.02 and P=.003 for linear trend, respectively) but stable ePASP (P=.11). Trends in both non-invasive ePASP and RV-PA coupling were similar in patients with and without pulmonary involvement (P=.48 and P=.79, respectively). Conclusions: In our large CS cohort with extensive follow-up, metrics of RV function and RV-PA coupling are often abnormal at CS diagnosis. Echocardiographic measures of PASP tend to remain stable but markers of RV dysfunction, including RV-PA coupling, tend to worsen throughout the disease course irrespective of pulmonary sarcoidosis. More granular phenotyping of pulmonary hypertension in CS is required to better understand this relationship.
Abstract 11916: Differences in Serum Transthyretin Levels Between Wild Type and Hereditary Transthyretin Cardiomyopathy Patients
Authors: Rebecca S Steinberg, Sreeram Yalamanchili, Austin Rim, Dhanish Revanth Rangaswamy Nandakumar, Rahul Patel, Matthew T Brown, Kunal Bhatt
Journal: Circulation (2022)

Introduction: Transthyretin (TTR), formerly called prealbumin, is a liver-secreted protein responsible for carrying thyroxine in the serum. Destabilization of TTR tetramers and subsequent deposition in the heart can cause cardiac amyloidosis, either spontaneously in a wild type (ATTRwt) form or in a hereditary form (hATTR). Lower serum levels may serve as prognostic indicators for patients with amyloid cardiomyopathy (CM-ATTR), but these levels can increase over time with the use of stabilization therapies such as Tafamidis. Hypothesis: The purpose of this study was to examine how TTR levels differ between ATTRwt and hATTR patients and patient characteristics associated with lower levels of TTR. Methods: We conducted a retrospective chart review of patients diagnosed with ATTR-CM with wild type or pV142I mutations enrolled in Emory University's Cardiac Amyloidosis Clinic between January 2014 and February 2022. We compared TTR levels between ATTRwt and hATTR patients at diagnosis, at 1-year follow up, and at 2-year follow up where data was available. We then stratified our cohort by Tafamidis use to compare TTR levels with and without the use of Tafamidis. Data are presented as median [interquartile range] and Mann-Whitney U test was used to compare TTR levels among groups. Results: Among 83 patients (22% ATTRwt, 78% hATTR), we found that hATTR patients had lower serum TTR levels at diagnosis compared to ATTRwt patients (wtATTR: 19.2 [14.8, 23.8]; hATTR: 14.3 [9.75, 17.9]; p=0.021), but that 1-year and 2-year TTR levels did not differ between groups. When stratifying by Tafamidis use, we found that there were no significant differences in TTR level at diagnosis and within 1 or 2 years of diagnosis between wtATTR and hATTR patients (Table). Conclusion: Patients with hATTR have lower serum TTR levels at diagnosis compared to ATTRwt patients at diagnosis. After Tafamidis use, both wtATTR and hATTR patients have similar levels of TTR.